Hospice in the Weald (HITW) a registered charity with nearly 25 years standing, and a voluntary provider of specialist palliative care and support services, would like to make the following submission to the Select Committee. It is hoped that the comments made are viewed as constructive and supportive to the work of the Committee and will provide a helpful insight into the issues which are preventing the development of palliative care in the UK and the contribution the voluntary sector can make to supporting the NHS.

  1.  Provision of services—HITW provides a comprehensive specialist palliative care service. The initial focus of support is provided by a team of Community Nurse Specialists (CNS). Liaison with Acute Hospitals, Consultants, GP's and District Nurses is an essential part in ensuring a joined-up service. Patients are visited in their homes, community hospitals and nursing homes. Emphasis is placed in addressing the needs of the patient and their carers. The changes in demographics and life expectancy means that more people reaching the end stage of their life need help and support from outside the family. The wishes of the patient are paramount. However, whilst initially patients may prefer to die at home, this situation changes as the patient's condition deteriorates.

  1(a)  Comment: The belief that patients can mostly be treated at home is overstated. Increasingly patients are able to visit the Hospice for day therapies and symptom control. It is then that the patient and their families realise that the patient would be more appropriately cared for in a Hospice, as compared to home or an acute hospital.

  2.  Equity of Provision—There is considerable variation of service provision around the UK. This situation has occurred due to variations in statutory funding and the difficulties of recruiting skilled nurses in certain geographic areas.

  2(a)  Comment: There is a need to encourage greater levels of co-operation and support between Hospices and NHS Hospitals. Secondment of nurses from acute hospitals and district nurses to hospices would benefit both the hospitals and the hospices with skills being passed on.

  2(b)  Comment: Greater emphasis needs to be given to encouraging and supporting nurses coming back to the profession. HITW would welcome the opportunity to be part of the educational programme by providing a clinical work placement at the hospice. Including the provision of mentorship and supervision.

  2(c)  Comment: HITW would like to teach palliative care to pre-registered nursing students, working in conjunction with teaching establishments. HITW would also support post-registration specialist courses.

  3.  The current Hospice nursing recruitment crisis has been made more difficult by the treatment of nurses wishing to rejoin the NHS Pension Scheme after a career break. Currently nurses can only rejoin after a break not exceeding one year unless they are joining an NHS establishment. This makes nurse recruitment at hospices less attractive as they are unable to join the NHS Pension scheme after a prolonged break.

  3(a)  Comment: Hospices should be eligible to take up membership of the NHS Pension Scheme in the same way that staff of General Medical Practices were able to do since September 1997.

  4.  Financial constraints—The levels of statutory funding provided to hospices varies dramatically across the Health Economies. PCT with inherited deficits are required to reduce these deficits at the expense of addressing current funding issues. Most statutory funding is based on past negotiations and therefore does little to take care of existing needs of a community.

  4(a)  Comment: Statutory funding should be based on the provision of assessed core services and the core costs associated with these services. This would ensure that hospices provide a cost efficient service to its community and would enable adequate budgetary and planning of service delivery to take place.

  5.  Administration—Many hospices find that they are being burdened with unnecessary legislation and reporting, whilst facing additional costs imposed from Central Government. NI contributions, cost of CRB checks, NCSC registration fees have all produced increases without additional state funding. The recently announced increases in the NHS Pension contributions are being supported by extra Government funding but the basis of calculation will result in a shortfall of funding compared to the actual cost increase.

  5(a)  Comment: A fairer contribution to hospice funding to meet these additional costs is essential, otherwise a cut back in services is unavoidable.

  In conclusion of this submission I would like to emphasize that independent hospices generally and my Hospice in particular are totally committed to working with our NHS colleagues to support the healthcare system. However, the funding situation is in serious need of review to ensure that the vital palliative care services provided by hospices are not undermined. If this situation is not addressed there will be a fall back on the NHS to support more terminally ill patients and this would not be cost effective or appropriate.

February 2004